Application of the Y-method for Two Cases of Intradural Tumor in the Lumbar Region

We excised intradural tumors in the lumbar region by en bloc laminectomy using the Y-method. Incisions were made in the dura mater and arachnoid membrane using a T-saw to expose the surgical field. The laminectomy involved repositioning of the resected vertebral arches into their original positions and performing suture fixation with absorbable sutures. Bone fusion was achieved in the vertebral arch and spinous process, with posterior elements of the lumbar vertebra successfully preserved. The first case was a schwannoma and the second was a relatively rare epidermoid cys

Surgical Outcomes of Posterior Short Segment Fixation for Thoracolumbar Burst Fractures: A Study of Patients Treated without Vertebroplasty

There is no widespread agreement regarding the treatment of thoracolumbar burst fractures. While performing posterior short segment fixation of thoracolumbar burst fractures, we evaluated therapeutic outcomes in patients treated with screw insertion into fractured vertebral bodies without vertebroplasty. We also investigated the limitations associated with the treatment of burst fractures when vertebroplasty is not performed. Twenty-one of 51 patients with thoracolumbar burst fractures who were treated surgically in Ohta Nishinouchi Hospital were evaluated in the present study. These patients underwent posterior short segment fixation with screw insertion into the fractured vertebral bodies (only pedicle screws were inserted one level above and one level below the fractured vertebral bodies) without vertebroplasty. Vertebral angles were measured before surgery, immediately after surgery, and at the final follow-up examination. Changes in vertebral angles were compared and analyzed. The mean vertebral angles before and after surgery and at the final follow-up examination were 15.4°, 6.6°, and 9.1°, respectively. The mean postoperative correction loss was 2.5°. The therapeutic outcomes of posterior short segment fixation with screw insertion into fractured vertebral bodies without vertebroplasty were generally favorable

A Case of Successful Foraminotomy for Severe Bilateral C5 Palsy following Posterior Decompression and Fusion Surgery for Cervical Ossification of Posterior Longitudinal Ligament

We report a very rare (5~7%) case of bilateral C5 palsy after cervical surgery. A 71-year-old male patient with cervical ossification of posterior longitudinal ligament (OPLL) with foraminal stenosis at bilateral C4/5 underwent posterior decompression and fusion surgery. After surgery, muscle weakness in his both deltoid and biceps was detected and gradually deteriorated to complete paralysis. Postoperative MRI showed sufficient decompression of the spinal cord and posterior shifting. Subsequently, an additional bilateral foraminotomy at C4/5 was performed, with a suspicion that bilateral foraminal stenosis at C4/5 may have been the cause of the paresis. After foraminotomy, muscular contraction was seen in both deltoid and biceps. Finally, complete motor recovery was achieved in a year. Although the gold standard procedure for the prevention and treatment of postoperative C5 palsy has not yet been established, an additional foraminotomy may be recommended for severe C5 palsy in cases of foraminal stenosis even after the occurrence of palsy

Treatment Outcome of Transforaminal Lumbar Interbody Fusion (TLIF) Using Unilateral Pedicle Screw Fixation for Lumbar Foraminal Stenosis

Transforaminal lumbar interbody fusion (TLIF) for both anterior/posterior and superior/inferior decompression of foramina can be indicated. The purpose of this study was to examine the outcome of unilateral TLIF and pedicle screw (PS) fixation for lumbar foraminal stenosis. The subjects were 24 consecutive patients who underwent monosegmental fusion for lumbar foraminal stenosis; there were 14 men and 10 women. All subjects underwent fusion at L5-S for unilateral L5 radiculopathy. A titanium cage was used in 10 subjects (titanium group) and a carbon or polyetheretherketone (PEEK) cage was used in 14 subjects (carbon/PEEK group). Clinical conditions and radiological findings were examined pre- and postoperatively, and at the final follow-up. The mean Roland and Morris Disability index improved from 8.5 preoperatively to 3.8 points. Excellent and good patient satisfaction was obtained in 2/3 of the patients. The mean disc height was increased by 2.0mm immediately after surgery and by 1.1mm at the final follow-up compared with the height before surgery. Subsidence of the cage of more than 3.0mm was observed in 60% patients of the titanium group and in 14% patients of the carbon/PEEK group (P<0.05). Unilateral TLIF and PS fixation was demonstrated to be less invasive for paravertebral muscles with a lower incidence of adjacent lumbar foraminal stenosis, resulting in a good outcome. Although there was no significant difference in clinical outcomes, subsidence of the cage was 4-fold higher in the titanium cage group than in patients receiving the carbon/PEEK cages. These findings indicate that unilateral TLIF and PS fixation are useful procedures

The Protective Effect of Fermented Milk Kefir on Radiation-induced Apoptosis in Colonic Crypt Cells of Rats The Protective Effect of Fermented Milk Kefir on Radiation-induced Apoptosis in Colonic Crypt Cells of Rats

To evaluate the effect of fermented milk kefir on X-ray-induced apoptosis in the colon of rats, we examined the apoptotic index, the mean number of apoptotic cells detected by H&E staining per crypt in the colon, in control rats and kefir-pretreated rats drinking kefir for 12 days before irradiation. Apoptotic cells were confirmed by TUNEL staining, and active caspase-3 expression was studied by immunohistochemistry. The cell position of apoptotic cells and active caspase-3 positive cells were examined. The apoptotic index of kefirtreated rats was significantly (p < 0.05) decreased 2 h after 1 Gy irradiation in comparison with control rats at crypt cell positions 1-3, 5-7, 13, and 15. Active caspase-3 expression in the kefir-treated rats was also significantly (p < 0.05) reduced in comparison with control rats 2 h after 1 Gy irradiation at crypt cell positions 1-4, 13, and 15. This study indicated that kefir protects colonic crypt cells against radiation-induced apoptosis, which was most pronounced in the stem cell region of the crypt. The antiapoptotic effect of fermented milk kefir was due to the inhibition of caspase-3 activation

Risk factors predicting osteosarcopenia in postmenopausal women with osteoporosis: A retrospective study.

There is growing interest in "osteosarcopenia" as the coexistence of osteoporosis and sarcopenia exacerbates negative outcomes. However, limited information is available regarding the risk factors of osteosarcopenia development in patients with osteoporosis. Therefore, we retrospectively reviewed 276 consecutive patients with postmenopausal osteoporosis who regularly visited Showa University Hospital. Patients were eligible for the study if they were ≥65 years of age and underwent dual-energy X-ray absorptiometry, blood sampling, and physical performance assessment. Patients were divided into the osteosarcopenia and osteoporosis alone groups according to the diagnostic criteria of the Asian Working Group for Sarcopenia. Of the 276 patients with osteoporosis, 54 patients (19.6%) had osteosarcopenia. Patients in the osteosarcopenia group had a greater risk of frailty than did those in the osteoporosis alone group (odds ratio 2.33; 95% confidence interval, 1.13-4.80, P = 0.028). Low body mass index seemed to be the strongest factor related to the development of osteosarcopenia, and none of the patients in the osteosarcopenia group were obese (BMI ≥27.5 kg/m2). Multiple logistic analyses revealed that patients aged 65-74 years who had comorbidities such as kidney dysfunction and high levels of HbA1c were at risk of developing osteosarcopenia. Thus, we strongly recommend the assessment of the key components of the diagnosis of osteosarcopenia in an osteoporosis clinic for patients with low body mass index. Furthermore, appropriate assessments, including comorbidities, will help in identifying patients at greater risk of developing osteosarcopenia